Endotoxin, Virus, and Bacterial Removal: Why, When, and How?

Sepsis is defined as a life-threatening organ dysfunction caused by a dysregulated host response to infection, and where underlying circulatory, cellular, and metabolic abnormalities contribute to a greater risk of mortality than that posed by sepsis alone, this may be considered septic shock where circulatory support is needed in the face of a raised lactate level. The main pillars of therapy remain source control and appropriate timely antibiotics, resuscitation where needed, and adequate source control. However, in the setting of organ failure further support may be needed.

Here, we discuss the potential benefits from removal of pathogens using available extracorporeal techniques. Although randomized controlled trials supporting such an approach remain elusive, this is due to change in the next few years with current studies being performed. The use of extracorporeal blood purification therapies is a promising therapeutic strategy for critically ill ICU patients with high pathogen load refractory to conservative treatment or with elevated endotoxin levels.

By targeting specific inflammatory mediators and pathogens, extracorporeal blood purification can help mitigate the severe inflammatory response associated with sepsis which should translate into improved patient survival. This approach may be particularly beneficial in cases where traditional treatments fail highlighting the need for further data to optimize the use of blood purification therapies in sepsis management.